Sold Case Binding Requirements

• MMC’s disclosure statement must be signed by the group and the TPA (in-force TPA’s only.)  The document may be signed no earlier than 30 days prior to the effective date of the policy.

• If the proposed TPA is the in-force TPA, a 12-month aggregate report is due no later than 15 days after the effective date.

• If the proposed TPA is not the in-force TPA, an 11-month aggregate report is required.  Groups that have no claims experience (130 lives or less) are exempt from this requirements

• A final census is required for all groups.  If the final census differs by 10% or more from the number of lives in the original census submitted in the request for proposal, MMC reserves the right to adjust the rates and factors accordingly.

• Binder check

Renewals:

 The TPA will receive a notification letter from MMC’s underwriting department requesting the following:

• An updated census.
• Current 10-month aggregate report (if applicable).
• Notice of any shock claims.
• Any changes to the plan implemented in the current year.
• Dollar amounts of claims awaiting funding.
• Pended claims.
• Denied claims.